Suchergebnisse

Abstract
Late-onset hypogonadism (LOH) is a clinical and biochemical syndrome associated with age and featured by typical symptoms and reduced blood testosterone level. Among males aged over 30 years, the incidence of androgen deficiency is 7 to 30%. The aim of this study was to investigate the incidence of hypogonadism in patients aged over 40 years with an underlying condition and/or a comorbidity, such as arterial hypertension, Chronic obstructive pulmonary disease (COPD), metabolic syndrome, Type 2 of diabetes mellitus, dyslipidaemia, adiposity in various General practice (GP) and physician-sexologists' offices in Latvia, and to determine the influence of chronic diseases on the development of hypogonadism. Males aged 39 years who turned to family doctors at nine GP were offered to fill in Aging Male Study (AMS) questionnaires used for the diagnostics of late-onset hypogonadism. Males aged 40 years who visited the office of the physician sexologist Anatolijs Požarskis were offered to fill in the same questionnaires. After compiling the data from AMS questionnaires, a group of males exhibiting signs of LOH were isolated (in total 1222 persons). In these patients, we determined blood testosterone and sex-hormone binding globulin (SHBG) levels. Chronic diseases were found in these men in data evaluation of patient medical records, and after performing physical and laboratory examinations. Late-onset hypogonadism was laboratory-diagnosed in 79% of patients with signs of late-onset hypogonadism in accordance with the AMS questionnaires and with concomitant diseases and in 4.7% of patients with signs of late-onset hypogonadism in accordance with the AMS questionnaires and without the aforementioned concomitant diseases. Persons with arterial hypertension, dyslipidaemia, adiposity, metabolic syndrome, COPD and Type 2 of diabetes mellitus had higher chance of developing hypogonadism (p < 0.001). Arterial hypertension, dyslipidaemia, adiposity, metabolic syndrome, COPD statistically significantly (p < 0.001) decreased the level of total testosterone by 0.47, 1.18, 0.36, 0.67, and 0.18 ng/ml, respectively, and decreased the level of free testosterone by 2.52, 2.71, 1,69, 6.77, and 4.58 pg/ml, respectively. Type 2 diabetes mellitus had no statistically significant effect on the level of total and free testosterone (p = 0.95, p = 0.10). The most significant decrease in the level of testosterone was observed in cases of dyslipidemia, COPD and metabolic syndrome. General physicians should pay special attention to patients with this disease, as these patients belong to a group with a high risk of development of expressed LOH syndrome.

Abstract
Right ventricle (RV) dysfunction in patients with ST elevation myocardial infarction (STEMI) is more common and important than previously considered. The aim of this study was to determine the incidence of RV involvement in acute STEMI by using advanced echocardiography (Echo) methods, such as RV longitudinal strain and three-dimensional (3D) ejection fraction, and to prove that RV involvement is not exclusive to right coronary artery damage in STEMI. The study group was formed of 73 patients aged 30 to 60 years with confirmed first-time acute STEMI and coronary angiography performed. Abnormality thresholds for standard and advanced Echo parameters in case of STEMI for predicted RV dysfunction were RV 3D ejection fraction < 49% and RV free wall longitudinal strain > –24.5 %. Using these abnormality thresholds it was possible to detect RV dysfunction in 60% of STEMI cases. The acquired results are close to the cardiac magnetic resonance data found in literature, which is the gold standard for determination of RV systolic function. RV involvement did not depend on the damaged coronary artery, as there was no association detected (p = 0.09); therefore, RV function should be assessed in every STEMI patient, and Echo is an effective method for this purpose.

Abstract
There has been an increasing tendency of infections caused by multidrug-resistant organisms (MDRO), including multidrug-resistant Acinetobacter baumannii (MDRAB), in the Rīga East University Hospital (REUH) during the last decade. Over the last two years (2014-2015), this tendency has reversed and the prevalence of MDRAB has decreased considerably. In this study we assessed the prevalence of MDRAB in intensive care units (ICUs), internal medicine, surgery units and analysed antibiotic sensitivity profiles. In addition, we determined if current infection control measures are preventing further increase of infections caused by MDRAB in REUH.
Retrospective Acinetobacter baumannii prevalence data were collected for the period from 2009 until 2012. For the time period from the beginning of 2013 until 2015, after implementing such infection control measures as control of compliance to hand hygiene guidelines, a review of central venous catheter insertion protocols and regular search for sources of MDRAB in hospital environment, prospective follow-up of new cases was conducted. Antimicrobial sensitivity profiles were assessed for the period from 2013 until 2015. Data were processed with the statistical software WHONET 5.5. Bacteria identification and antibiotic susceptibility testing were performed by VITEK 2 compact, BioMerieux, France. The prevalence of MDRAB in the period 2009 to 2013 increased from 71 to 217 cases per year, but from between 2013 (time of implementing infection control measures) and 2015 it decreased to 113 cases in 2015. In the three year period (2013-2015), the proportion of MDRAB causing bloodstream infections (BSI) and central nervous system infections (CNSI) was 15.85% from all identified MDRAB cases. Of the 113 MDRAB infections diagnosed in 2015, BSI was found in 16.81% cases (n = 19). Antibiotic resistance testing showed that colistin is the most effective drug against MDRAB. The majority of Acinetobacter baumannii isolates were resistant to Ampicillin/Sulbactam, Piperacillin/Tazobactam, Ceftazidime, Cefepime, Imipenem, Meropenem, Amikacin, Gentamicin, Tobramycin, and Ciprofloxacin. Over the last two years (2014-2015), prevalence of MDRAB infections decreased considerably. In the time period from 2013 to 2014, resistance of Acinetobacter baumannii increased to imipenem, ciprofloxacin and colistin, while decreased slightly to amikacin. Rigorous infection control measures, such as identification and elimination of new MDRAB sources in environment, review of the central venous catheter insertion protocol and improvements in hand hygiene, are crucial for decreasing distribution of and invasive infections caused by MDRAB in the hospital environment.

Abstract
Rosacea is a chronic inflammatory skin disease characterised by transient or persistent erythema, telangiectasia, papules, and pustules that predominantly involve central regions of the face. Recent studies have shown a possible clinical association between rosacea and cardiovascular diseases (CVDs). Rosacea and atherosclerosis are both known to have alterations in the innate immune system, enhanced oxidative and endoplasmic reticulum stress. The aim of this review is to delve deep into the pathogenesis of rosacea and atherosclerosis to uncover possible pathogenic overlaps between these chronic inflammatory diseases.

Renal anaemia: the role of haemoglobin control in patients with chronic kidney disease
Chronic kidney disease (CKD) is a significant and prevalent health problem in the world. Anaemia is one of the most common manifestations in patients with CKD. The correction of anaemia with erythropoietin normalises haemoglobin level and improves quality of life. Many aspects of the impact of anaemia treatment with erythropoiesis-stimulating agents on the progression of CKD remain unresolved and disputable. The present study is a retrospective chart review of 1654 outpatients with CKD. The data were collected from the Centre of Nephrology between 1 January 2002 and 31 December 2006. The aims of the study were to assess the causes of CKD; the prevalence of anaemia based on the current guidelines for anaemia management in CKD (Kidney Disease Dialysis Outcomes Quality Initiative; K/DOQI); to evaluate haemoglobin (Hb), systolic and diastolic blood pressure (SBP and DBP), glomerular filtration rate (GFR) at the first referral to a nephrologist and at the start of renal replacement therapy (RRT). The most common causes of CKD were arterial hypertension (17.2%), chronic glomerulonephritis (17.2%), chronic intersticial nephritis (13.3%), and diabetes (12.8%). Twenty-three percent of end-stage renal disease (ESRD) patients had diabetes mellitus. At the first visit in the renal department, 16% of the patients had an advanced degree of CKD (GFR <30 ml/min). The proportion of patients under an observation in the kidney centre for a period of six months and more was only 34% (554 of 1654). Hypertension was recorded in 72% of study subjects. The blood pressure (BP) values in patients at the first visit (n = 1633) vs. at the start of RRT (n = 154) were: mean SBP 147.4 ± 24.8 mm Hg vs. 152.2 ± 23.0 mm Hg (P < 0.05); mean DBP 88.8 ± 13.6 mm Hg vs. 88.4 ± 12.0 mm Hg (P 0.05). Anaemia was recorded in 41% of study subjects, estimated using K/DOQI recommendations. The prevalence of anaemia was increased from 30.2% to 44.8% of study patients with a rise of BP (from normal BP to hypertension; P < 0.05). The mean Hb level at the start of RRT was 9.8 ± 2.1 g/dl. Only 18% of patients with renal anaemia had used erythropoiesis-stimulating agents before RRT (28 of 155). Anaemia is the prevalent condition at moderate degrees of CKD. The severity of anaemia in the CKD population is determined by evidence of diabetes, cardiovascular disease, and renal function. Anaemia may often be unrecognised or untreated.

Abstract
Based on epidemiological data, osteoarthritis (OA) is the most common joint disease of populations of industrialised countries. The increasing prevalence of OA is closely related to an ageing population and a sedentary lifestyle. Load-bearing joints, such as hip, knee, and intervertebral joints, are the primary ones that are being subjected to the degenerative changes. The patho-physiology of the disease is based on progressive damage and gradual deterioration of the micro and macrostructure of hyaline cartilage. In today's radiological practice, the first-line method for assessing the condition of articular cartilage is magnetic resonance imaging (MRI). However, the sensitivity of standard clinical MRI in articular cartilage assessment is limited. For this reason, for the last five years there has been a rapidly growing interest in developing advanced MRI techniques for cartilage structure evaluation. The purpose of this pilot study was to highlight the possibilities of Artificial Intelligence Computed Vision Analysis (MEDH 3.0 algorithm) in the evaluation of cartilage changes of the knee joint. The study was carried out at Rīga East Clinical University Hospital (RAKUS) and included 25 patients. After assessment by a rheumatologist, the participants were divided into two groups: 15 (60%) participants with OA and 10 (40%) healthy individuals. All patients underwent MRI examinations according to a unified RAKUS Gaiïezers Radiology clinic protocol. MRI data were analysed using the Computed Vision Analysis MEDH 3.0 algorithm. The results showed substantial differences in intensity variance (p < 0.01) parameters, as well as in pixel entropy and homogeneity values (p < 0.01). The results of the pilot study confirmed the potential use of Artificial Intelligence Computed Vision Analysis in further development and integration in the assessment of cartilage changes in the knee joint.

Abstract
Immunoglobulin A nephropathy (IgAN) is the most common chronic glomerulopathy with variable clinical manifestations. IgAN diagnostics became possible in Latvia in 2013. The study aim was to describe IgAN manifestations in the Latvian population by analysing epidemiological, clinical, histological data, and reveal factors that might determine the course of the disease. The retrospective, one-centre study included biopsy-proven IgAN patients over a five-year period in the Nephrology Centre at Pauls Stradiņš Clinical University Hospital. Data from inpatient and outpatient medical records were collected. The study included 69 patients with histologically confirmed IgAN (23% of all renal biopsies): 52% men with mean age of 37. More than a half of them had hypertension, changes in urinalysis and kidney structure, and GFR < ml/min before the biopsy. Pathology data stratified by MEST-C score were: M1 (93%), E1 (5%), S1 (81%), T1 and T2 (24%), C1 (18%). 20% started renal replacement therapy (RRT). Proteinuria, obesity, hyperuricemia, high total MEST-C score, and low serum C3 were associated with a worse prognosis. As a significant part of patients start RRT in the five-year period after the biopsy, the disease course is not benign. IgAN in the study population was diagnosed with clinical and histological signs of advanced disease.

Abstract
Autoimmune thyroid diseases (AITD) mainly include Hashimoto's thyroiditis (HT) and Graves' disease (GD), which are characterised by the presence of circulating antibodies against various thyroid autoantigens and infiltration of the thyroid gland by autoreactive lymphocytes. Despite the significant advancement in the knowledge of AITD pathogenesis in the last decade, the specific immunological mechanisms responsible for development of the disease are not thoroughly understood. Classically, HT has long been considered as a T helper (Th)1-mediated disease, while a Th2-driven autoimmune response is dominant for GD development. However, this classification has changed due to the description of Th17 lymphocytes, which suggested participation of these cells in AITD, particularly HT pathogenesis. Moreover, a shift in the balance between Th17 and T regulatory (Treg) cells has been observed in thyroid autoimmunity. We have observed overexpression of IL-17, the prominent effector cytokine of Th17, within thyroid tissues from HT and GD patients in our studies. The present review will focus on recent data regarding the role of Treg and Th17 lymphocytes in AITD pathogenesis. In addition, the impact and proposed mechanisms of the predominant environmental factors triggering the autoimmune response to the thyroid will be discussed.

Abstract
Coronary artery chronic total occlusions (CTO) are common — approximately one-third of patients with significant coronary artery disease on angiography have at least 1 CTO. Invasive treatment of these lesions still remain a major challenge for interventional cardiology due to their complexity. Historically, success rates have improved to about 60–70% by using only the traditional antegrade approach. The results have dramatically improved during the last decade after more widespread application of new retrograde techniques. The aim of our study was to review and analyse single hospital experience in CTO invasive treatment and to evaluate the long-term results. A total of 519 patients undergoing percutaneous coronary interventions (PCI) for CTO at a single tertiary PCI centre (Rīga East University Hospital), were included in the study. The median age was 64 years (38–88), and 80% were male. The retrograde approach (RA) was used for 167 (32.2%) of the CTO PCI patients. The overall patient success rate was 81.3% and it increased from 73.9% in 2007 to 95.2% in 2015 (p < 0.001). Mean patient observation time was five years. Overall survival was found significantly better in patients group after successful CTO PCI procedures (Long-rank test, p = 0.013).

Abstract
Daily intake of cereal fibre reduces incidence and progression of metabolic diseases. Very little is known on how triticale (Triticosecale) influences human health and its role in regulating carbohydrate metabolism. The aim of the study was to investigate glycaemic and insulin response in blood after consuming whole grain triticale cereal flakes. A group of twelve healthy, young people, aged from 18 to 30 years participated in the test. The participants in fasted state were given equivalent carbohydrate amounts of triticale cereal and reference food (glucose solution). Postprandial blood glucose and plasma insulin concentrations were measured according to Brouns et al. (2005). Whole grain triticale cereal flakes elicited lower metabolic responses compared to glucose solution. Intake of the triticale cereal flakes induced significantly lower incremental insulin area (iAUC 0–120 min) 1672.9 ± 619.85 than glucose solution 2646.65 ± 1260.56 and showed lower insulinemic indices (II) 68 ± 19.0 (p < 0.05). A low insulin incremental peak was associated with less severe late post-prandial hypoglycaemia. Our study showed that triticale cereal product caused low acute insulinemic response and improved glycaemic profiles, similarly to the rye products studied before. The results also suggested that the triticale cereal flakes could have beneficial appetite regulating properties. Thus, triticale flakes would be a wonderful option for functional breakfast cereal mixtures that might influence course of metabolic syndrome prevention

Abstract
The significance of carbohydrate (cancer) antigen 125 (Ca-125) and carcinoembryonic antigen (CEA) tumour markers levels in differential diagnostics of malignant and benign pleural effusion was studied. Within this prospective study, 121 patients with fluids of various aetiology in the pleural cavity were analysed. Malignant pleural effusion was detected in 55 patients, parapneumonic effusion in 28 patients, transudative effusion of cardiac origin in 31 patients, pancreatitis in one patient and tuberculous pleurisy in five patients. The highest accuracy in diagnosis of malignancy was observed for Ca-125 and CEA levels in the pleural fluid: 75.2% at cut-off value ≥1452 U/mL and 76.9% at cut-off value ≥6.58 ng/mL, respectively. We conclude that the level of tumour markers in pleural fluid has additional diagnostic significance in the differential diagnosis of malignant and benign pleural effusions.

Abstract
This study aimed to determine peripheral blood mononuclear cells' (PBMC) proliferative response to parvovirus B19 (B19) antigens in rheumatoid arthritis (RA) patients and possible changes in proliferative response due to chemotherapy. Serum and blood samples of 52 RA patients and 25 sex and age matched healthy individuals were examined for the presence of anti-B19 IgG and IgM class antibodies and virus specific DNA sequence by the recomLine B19 test and nested polymerase chain reaction, respectively. The PBMC proliferative activity was estimated on the 3rd and 6th day of PBMC cultivation in the presence of virus and B19 VP1/VP2 peptide, using thymidine incorporation assay. On the 3rd day, PBMC response to B19 antigens was detected in 74.1% RA patients with active, in 44.8% - with remote and in 40% - with latent stage of persistent B19 infection, while in the control group the response was observed only in two individuals with active viral infection. On the 6th day, the response was found in 50% RA patients with active, 68.9% - with remote and in 80% - with latent stage of latent persistent infection as well as in 41.1% remotely infected control individuals. The highest PBMC mean stimulation indices were detected in the RA patients and control persons with active infection as well as in RA patients with latent stage of persistent viral infection. On the 3rd and 6th day, strong proliferative response was significantly more frequently observed in RA patients not receiving methotrexate treatment, compared to the patients receiving methotrexate treatment in different combinations with other drugs. RA patients had more frequent and faster response to B19 antigens than apparently healthy persons.

Association between Inflammatory Markers and Clinical and Metabolic Risk Factors for Cardiovascular Diseases
The inflammatory reaction plays an important role in the development of atherosclerosis. The clinical significance of the main inflammatory markers — C-reactive protein (CRP), interleukin 6 (IL6), tumour necrosis factor alpha (TNF-α), plasminogen activator inhibitor 1 (PAI1), etc. — has not been fully established. CRP, IL6, TNF-α, and PAI1 were assessed in 100 patients in terms of certain clinical indicators (sex, obesity indicators, blood pressure, and heart rate), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglycerides (TG), glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), adiponectin, and leptin levels. CRP and PAI1 levels were elevated in subjects with increased body mass index (BMI) and waist circumference. CRP correlated positively with indicators of carbohydrate metabolism and negatively with TC, HDL-C, and adiponectin. PAI1 correlated positively with insulin levels, HOMA-IR, leptin, and TG, but negatively with HDL-C. IL6 correlated negatively with TC, but TNF-α correlated negatively with HDL-C. Both IL6 and TNF-α correlated positively with leptin levels. TNF-α correlated with TG levels and the indicators of carbohydrate metabolism only in women. CRP and PAI1 are the most sensitive inflammatory markers; their levels were higher in adipose subjects.

Characteristics of Cardiovascular Risk Factors and Their Correlation with the Sex and Age of Patients in the Latvian Population
Various cardiovascular risk factors (RFs) were determined in 773 out-patients (mean age 55.8 ± 14.5 years). Male individuals had a larger waist circumference (WC) than did female patients (99.1 ± 13.6 cm vs 93.3 ± 15.2 cm), higher diastolic blood pressure (DBP) (83.6 ± 9.6 mmHg vs 81.8 ± 9.6 mmHg), and higher levels of blood glucose (5.73 ± 1.4 mmol/L vs 5.49 ± 1.3 mmol/L) and triglycerides (TG) (1.89 ± 1.3 mmol/L vs 1.60 ± 1.0 mmol/L), but lower levels of total cholesterol (TC) (5.54 ± 1.2 mmol/L vs 5.79 ± 1.2 mmol/L) and high-density lipoprotein cholesterol (HDL-C) (1.21 ± 0.4 mmol/L vs 1.44 ± 0.4 mmol/L). Compared with the younger age group (i.e., males, < 7 years; females, < 65 years), patients in the older age group had a larger WC (98.4 ± 14.2 cm vs 92.8 ± 15.1 cm), higher systolic blood pressure (SBP) (144.2 ± 19.2 mmHg vs 131.6 ± 18.5 mmHg), higher DBP (84.5 ± 8.8 mmHg vs 80.9 ± 9.8 mmHg), higher blood glucose level (5.74 ± 1.3 mmol/L vs 5.46 ± 1.3 mmol/L), and higher low-density lipoprotein cholesterol level (LDL-C) (3.68 ± 1.0 mmol/L vs 3.52 ± 1.0 mmol/L), but lower HDL-C level (1.3 ± 0.4 mmol/L vs 1.41 ± 0.4 mmol/L). Age was significantly correlated with all RFs, with the exception of the level of C-reactive protein. In conclusion, analysis of cardiovascular RFs in different age subgroups of both sexes clearly showed individual peculiarities of risk profile. This conclusion challenges the usual way of risk calculation using "universal" markers like adiposity or dyslipidemia in all population. The new approach requires individual attention depending on sex and age also in management of risk.

Abstract
Acinetobacter baumannii is an aerobic gram-negative opportunistic bacterial pathogen, an emerging cause of healthcare-associated infections, associated with increased morbidity, mortality and healthcare costs. It has been widely found in the hospital environment, exhibiting high resistance to antimicrobials, affecting the spread of healthcare-associated infections and preventing effective infection control. The role of virulence factors in the pathogenesis of A. baumannii related human infections remains unclear. Therefore, molecular testing of pathogenic bacteria is an important tool for improving infection control measures against A. baumannii with combined resistance. The aim of this study was to analyse A. baumannii infection cases, antimicrobial resistance profiles and to characterise the genetic heterogeneity of isolates. In general, outbreaks occurring in hospitals are presumed to be clonal, with patient-to-patient transmission of essentially identical strains. Treatment decisions are based on a combination of in vitro susceptibility assays and empirical results based on patient outcomes.